6 FLINT ST - BUILDING INSPECTION or- 6, To-f iso
The Commonwealth of NTaEsad (tA v3 C.r :.
- Department of Public Safety
Massachusetts State Building Code MB V 1
Building Permit Application for any Building other than a One-or w a t� welling
(This Section For Official Use Only)
B g it Number: Date Applied: Building Official:
SECTION 1:LOCATION
L dr rt
No.and Street City/Town Zip Code Nam f Building(if applicable)
1 Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here❑ or check all that apply in the two rows below
Existing Building❑ 1 Repair❑ Alteration ❑ 1 Addition❑ Demolition ❑ (Please fill out and submit Appendix 2)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: fi /,-rT—
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineerin�j Peer'Rewienw required? LYe—s ❑ No ❑
Brief Description of Proposed ork: I yl3 i�'� Gt_ I7T— T!dYh
7 lvT�OG
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) [
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional 1-1 ❑ I-2❑ I-3❑ 1-4❑ M: Mercantile❑ 1 R: Residential R-10 R-2❑ R3❑ R-4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IBD ILA [ IIB [ IIIAD IIIB13 1 IV ❑ I VA [ VB [
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information:., Sewage Disposal: Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
�O Private❑ or indentify Zone: or on site system❑ required ❑or trench or specify:permit is enclosed❑
�} Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No❑ Yes ❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
Dig 7s(� OA.C, lQct- 6 47/d
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SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Add(r�ss of Property Owner p
Cgy eezzty /_..S > Q ri O197o
Name(PriAtf No.and Street City/Town Zip
Property Owner.Contact Information:.
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
gY aan-/)U_PIr7C S� ja_4e.,, d/�s� ai97o
�/ Name Street Address City/Town state Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) _
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0..
Otherwise provide construction control forms see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordin ting document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date -
10.2 General.Contractor - -
7 /
Company Name
�1�dr dr'r-a�4
Namelofperson.Responsr e for Construction / License No. and Type if Applicable '
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Street Address City/Town/ State Zip
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Telephone No.(business) Telephone No. (cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§ 25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes 0 No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and Materials) Total Construction Cost(from Item 6)_$ lQ 75-
1.Building $ Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT -
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accura to the best of ay k ledge and understanding. -
�Nia.� �ilcr�re
P�lwseJ�mt and/si name Q � / ' �Tide T lephone No.' Date
%i/ Y'�g (/�/LGe2 '�L�L D��d i•'l� r2.h-fie v,4 o
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: " l�
Name Date
Certificate of Flame Resistance
REGISTERED ISSUED BY Date of Manufacture
FABRIC JOHNSON OUTDOORS INC.
NUMBER BINGHAMTON,NEW YORK 13s02 MAY 2007
F-140.01 Manufacturers of the Finest
i Tent Products DesWbed Herein
i
This is to certify that the products herein have been manufactured from material inherently flame retardant as
here after specified by the material supplier.
NAME: THEEVENTCO
CITY: GLOUCESTER,MA
cedineatlon Is hereby made that:
The ar0des described on Mis Certificate have been manufactured Win an approved name retardant cherrical in cempliance Will
r Catifonda State Fire Marshal Code.NFPA-701'.Underwiter Labmatwy of Canada,and have been tested in emardanCs with the
j F
Tvm.color antl weioM of material 14 OZ vinN WHITE BLOCK OUT
1
Oescrioaon of item cenifred: EFS 70X30 2PC
Flame Retardant Process Used Will Not Be Removed By Washing And
i
Is Effective For The Life Of The Fabric
Snyder Manufacturing,Inc.
MenNacWmr e<Flame aelacdanl VinN lenJnaros TENT OEPARiMENT.bNNSON ZIN 4r9e Srale
i
4
t
Certificate of Flame Resistance
REGISTERED ISSUED BY Dato of Manufacture
FABRIC JOHNSON OUTDOORS INC.
NUMBER BINGHAMTON,NEW YORK t3g02 MAY 2009
F-140.01 Manuractunns of the Finast
Tent Pmduds Described Herein
This is to certify that the products herein have been manufactured from material Inherently Hama retardant as
here after specified by the material supplier.
NAME: THE EVENT GO.
CITY. GI.OUCESTER,MA
CeAflcation is hereby made that:
The articles described on this cerditate have bean manuracl and v4m an approved flame retardant dnemiral in ovnpliance wim
California State Fire Marshal Code,NFPA-701-.Underwiters tabommry 01 Canada.and have been tested In ecwrdence. 0,tho
Federal Test Method Specfimbons and meet or exceed the Maaary Flame Spedfirallons of MIL-C43008G.
Type,color and weight at material 14 0Z WBO
Desatoton of Item certifies EFS 15 MID 30 WBO
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
•- . Snyder Manufacturing,Inc.
Marudaelumr of Flare RabMre Vim1 l.onenaem TEM DmARI .JOMNSON.O
a
j Certificate of Flame Resistance
REGISTERED -
! FABRIC ISSUED BY _ Date of Manufacture
NUMBER JOHNSON OUTDOORS INC.
BINGHAMTON,NEW YORK 13902
F-740.01 Manufadun?m Of the Rnesr MAY 2007
I Tent PMCIUCIS Described Herein
i This is to certify that the products herein have been manufactured from material Inherently flame retardant as
hem after specified by the material supplier.
i
NAME: THE EVENT CO
jCITY: GLOUCESTER.MA
I certification is hereby made that:
The ariides desatbed an mis certiflrate have been manufactured with an aPpreved flame mtmdant chemical in OWnptiance Win
California State F Fim Marshal Code.NFPA-701•,Underwriters Laboratory of Canada,and have been tested in accordance with Ins
Tvoe.wbr aM weiaht of material 14 OZ vinyl WHITE BLOCK OUT
I
I
Deaaiotion o/it&n certified: EFS 10'M1D 70'
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
Snyder Manufacturing,Inc.
ManulxTrrer o/FWma Rebmenl YvM larrmbba TENT MPARTME ..WHMSON OUT
M
'Lmge Scab